Mitchell v. State of Washington

A state official's decision to deny a medical treatment option using an explicit racial classification is subject to strict scrutiny, but will be entitled to qualified immunity if the particular set of circumstances was not clearly established at the time that treatment was denied.

Prior to being committed to the Special Commitment Center as a “sexually violent predator,” George Mitchell was diagnosed with Hepatitis C. Mitchell met with two physicians regarding his Hepatitis C. The second physician, Dr. Bell discussed treatment options with Mitchell, one being the administration of interferon and ribavirin. Since those medications were weight-based Mitchell agreed to delay treatment until he could lose weight. Later he met with Dr. Bell who told him that interferon and ribavirin treatment had been unsuccessful for his genotype and on African-American males. Later Mitchell was placed on these medications but they were unsuccessful. Mitchell filed suit against Dr. Bell and Kelly Cunningham, the Superintendent of SCC alleging that Dr. Bell’s rejection to refer him for this treatment violated his Fourteenth Amendment right to reasonable medical care and the consideration of race in denying treatment violated the Equal Protection Clause. The Magistrate Judge recommended that Defendants’ motion for summary judgment be granted, holding that the allegations were barred by the Eleventh Amendment. The Ninth Circuit applied the Youngsberg standard, which presumes a professional decision to be valid unless the decision is a substantial departure from the accepted professional judgment. Documents submitted by Mitchell only showed that interferon and ribavirin were preferred treatment and a not specific standard of care, therefore Mitchell was unsuccessful in rebutting the Youngsberg standard. The panel held that strict scrutiny should apply to race based decisions in the medical context. Since Dr. Bell employed a racial classification when he decided not to recommend Mitchell for this treatment, strict scrutiny applies. However, Dr. Bell was entitled to qualified immunity because this particular set of circumstances, i.e. the use of “race-related success-of treatment data” as a factor in medical treatment, that would be unconstitutional, was not “clearly established” at the time treatment was denied. AFFIRMED.